Postinfectious IBS has been reported in up to 30% of patients with acute gastroenteritis, suggesting that the pathogenesis of IBS may be intimately linked to an altered intestinal microbiota.[47–49] The composition of the intestinal microbiota in patients with IBS has not been extensively studied, however, patients with constipation-predominant IBS have been shown to increase population of sulphate-reducing bacteria compared with healthy controls.[50] Probiotics can restore the intestinal microbiota in patients with IBS[49,51] and result in improvement of postinfectious IBS in animal models;[11] FMT, however, may prove more beneficial, as donated feces, in a sense, are the ultimate human probiotic.

In a case series of 55 patients with IBS and IBD treated with FMT, cure was reported in 20 (36%), decreased symptoms in nine (16%) and no response in 26 (47%) patients.[6] In another series, 45 patients with chronic constipation were treated with colonoscopic FMT and subsequent fecal enema infusions, 89% of whom (40 of 45 patients) reported relief in defecation, bloating and abdominal pain immediately after the procedure.[52] Normal defecation, without laxative use, persisted in 18 of 30 patients (60%) contacted 9–19 months later.[52]

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Key Points

Intestinal microbiota play a role to maintain health and to regulate cellular immunity and energy metabolism.FMT has a cure rate exceeding 90% worldwide for RCDI.

Case series report promising results for FMT treatment in IBD and IBS, however, randomized controlled trials are needed to validate clinical observations.

Studies are needed to determine whether FMT is a valid treatment for a wide variety of non-GI diseases including Parkinson's disease, autism, multiple sclerosis, chronic fatigue, and obesity among others.